This invention relates generally to methods for closing punctures and small wounds of the human body, such as those made by surgical trocars for performing endoscopic or thorascopic surgery. More particularly, the invention relates to a novel suturing method which allows such punctures to be sutured and closed with an internal seal on the puncture.
Many recent surgical techniques involve the use of trocar devices to create access to specific internal areas of the human body. Rather than requiring a relatively large incision to provide access for the surgeon, the new tools developed for endoscopic and thorascopic surgery allow work to be performed via entry through only a small opening in the body wall. In general, the trocar and its sleeve assembly are used to puncture the patient's skin, subcutaneous tissue, and internal tissue layers (muscles, fascia and peritoneum or pleura, for example) to provide access to an internal body cavity or area. After removal of the piercing trocar, the necessary procedures are implemented by introducing the surgical tools through valving mechanisms in the sleeve device.
Upon completion of the procedure, the sleeve is removed, leaving a puncture opening which must now be sealed. Traditional technique is to close the opening by suturing the outermost layers of skin and subcutaneous tissue. The interior portion of the puncture is not addressed, and usually the muscles and fascia will seal the defect in due course. In some cases, the surgeon will attempt to suture the opening within the muscle and fascia layer, utilizing standard curved suturing needles. This is extremely difficult to accomplish due to the small size of the opening, usually 5 to 12 millimeters, and the task is further impeded by the overall length of the puncture, which can be of some distance for overweight patients. Use of a large curved needle makes recovery almost impossible after transfixing one side of the defect and a small needle will not sufficiently pass through the entire internal muscle-fascia tissue layer for proper suturing.
Without closure of the puncture defect from the interior, complications such as excessive bleeding, hernia formation, bowel strangulation or fluid migration into the internal tissue layers may occur. To solve this problem, a novel and unique technique has been developed for internal closure of small wounds and trocar punctures, whereby the internal tissue layers are sutured shut to seal the puncture defect internally as well as externally.
It is an object of this invention to provide a method for internally closing puncture openings in the human body, such as are created by surgical trocar devices, whereby the defect is sealed across the interior of the puncture by suturing.
It is a further object to provide such a method whereby the suturing material can be positioned prior to removal of the trocar sleeve, such that the closure can be accomplished immediately following removal of the trocar sleeve.
It is a further object to provide such a method whereby the puncture defect in the internal tissue layer can be closed by one or several sutures introduced through the skin opening of the puncture itself and passed through the internal layers, such that the sutures can be quickly tightened to seal the internal tissue layers and tied below the skin surface within the subcutaneous layer.